General Update #178 - October 3, 2020

Dusty and Jess arrived to farmhouse ~8:25 a.m. Joyce found to be awake and without oxygen line in place. Joyce was fairly alert, stating she had just taken herself to the bathroom earlier in the morning though she could not recall how long she had been back in the recliner. Dusty trained Jess on morning routines and location of all necessary materials for care of Joyce. Joyce stated that she was not very hungry and did not feel like eating breakfast today. Dusty negotiated breakfast, reminding her he picked up her special request item for today and she could have it for breakfast. 

8:36 a.m. - Vitals taken, blood pressure 144/79, pulse 82. Blood glucose level @ 147.

8:43 a.m. - Lidocaine patch applied.

8:45 a.m. - Breakfast (1 Rosauers doughnut, 1/2 banana, chocolate ensure). Morning medications administered (Carvedilol, extended relief metformin, multivitamin, iron, potassium, 2 Tylenol).

9:22 a.m. - Craig stopped into farmhouse to read through obituaries in the weekend paper and visit. Craig had been speaking with Carl and it was suggested that obtaining a bidet for the farmhouse to assist Mom with her toileting hygiene might be worth exploring. Dusty will begin obtaining options on bidets for review/proposal for install at next family meeting. Derik arrived to use bathroom and loitered to talk to Dusty while Craig was visiting. Craig departed ~9:32 a.m. Derik informed Dusty that his girlfriend was now visiting him on site at his camper and would need to use the bathroom in the farmhouse as well. Derik stated that he had already asked Connie if this was acceptable and she had given permission. Dusty told Derik that his girlfriend would just need to check in with family caregiver on duty and wear a mask when coming into the farmhouse. Derik agreed and departed.

Jess helped Joyce return her oxygen line into place. Jess sat and visited with Joyce, showing her the projects she brought with her to work on for her art business that she can make while providing care for Joyce. Jess let Joyce select one of the anthropomorphic plushie dolls she had made to keep her company.

10:04 a.m. - Another individual called the farmhouse line asking for Gritman Medical Center. This time they were wanting to schedule a COVID-19 test.

10:05 a.m. - Joyce declared she needed to use the bathroom and rose up to travel under her own power. Joyce declared "it was coming out!" and soiled herself (Type 6 bowel movement, pull up diaper did not contain it) as she stood up and walked away from the recliner, tracking fecal matter all along the red carpet until Dusty could get her to stop moving away from him. He managed to stop her forward movement as she reached the kitchen linoleum. Disposable mat put into place under Joyce and Dusty and Jess commenced removal of soiled clothing and cleanup of Joyce's body. Joyce moved to bathroom ~10:22 a.m. and passed remainder of bowel movement and urine. Jess cleaned kitchen carpet while Dusty cleaned Joyce and put her in for a shower. Joyce changed into fresh clothes and returned to recliner by ~11:18 a.m. Joyce expressed concerns and embarrassment over her inability to control her bowels or know when she has to go to the bathroom and causing messes for everyone to clean up. Jess and Dusty visited with Joyce, talking through her feelings, providing reassurance, and improving her morale and that they were there to care for her and loved her. Joyce requested to be allowed to nap.

1:02 p.m. - Vitals taken, blood glucose level @ 146. Blood pressure 139/75, pulse 80.

1:17 p.m. - Bathroom trip without incident. Joyce elated she had not had any incontinence issues. Wounds cleaned and fresh barrier cream applied. Several attempts made to weigh Joyce but she was unable to balance correctly without causing error on scale. Joyce returned to her recliner ~1:37 p.m.

Dusty departed farmhouse ~1:45 p.m., traveling into Moscow to pickup lunch and his carpet cleaner machine and chemicals for use at the farm to clean the kitchen carpet. Jess remained at farmhouse with Joyce and visited with her while working on projects for her business.

2:50 p.m. - Bathroom trip. Urinary incontinence issue requiring change of diaper pad insert. Remainder of urine passed. Joyce returned to recliner ~3:10 p.m.

3:17 p.m. - Lunch (Panda Express teriyaki chicken and noodles with cabbage removed). 2 Tylenol provided for pain relief.

4:50 p.m. - PT walk outside around patio with Jess and Dusty using portable oxygen. Joyce was sat down on patio chair while Jess watered remaining living plants on the patio and Dusty began winterizing the pots. Joyce lamented that her grapes on the patio did not look like they had been watered and have possibly perished. Joyce enjoyed just being able to sit outside in the nice afternoon air on her own patio. While Joyce was sad she "missed summer" by being at Aspen Park through July and August, she found the upside was that she missed the terribly hot days and did not have to be outside in them.

Joyce moved indoors ~5:25 p.m. for bathroom trip without incident. Joyce elated that she did not have a urinary incontinence issue since last bathroom trip given her walk outdoors and time since last bathroom trip. Joyce returned to her recliner ~4:40 p.m. and napped off and on through remainder of evening hours, visiting briefly at random intervals when she woke enough to talk. 

~8:42 p.m. Joyce thought that Dusty had left the farmhouse to talk with someone. Dusty had stepped outside to briefly to get some fresh air but no one else was at the farmhouse besides Jess (who had stayed in the kitchen with Joyce). Joyce had been napping and possibly had been dreaming.

~9:03 p.m. - Jess and Dusty discussed "actual Joyce" vs. "tired Joyce" when Joyce wanted to discuss her PT and OT and how "tired Joyce" prevents the PT and OT plans from occurring most days. Joyce stated that before people were present with her, she would not take her evening pills some nights. Jess explained that was one of the reasons that people needed to be present to care for Joyce (to ensure her medication regimen was kept intact). Joyce remembered that the Aspen Park nurses would give her evening medications at night. Joyce thought that being at home and going outside today was good for her. Jess reiterated that if Joyce wants to go outside there needs to be two family caregivers present to help her make it up and down the patio steps as she does not use the walker correctly, has balance issues, and her mobility is not 100% reliable at all times. 

Joyce stated that her driver's license was still good. Jess informed Joyce that her driver's license has expired. Joyce exclaimed that was terrible. Jess reviewed instances of Joyce's diminished capacity and abilities to operate a motor vehicle and that the family would drive her anywhere she wanted to go and get her anything she needed from town. 

Joyce continued to have difficulty in comprehending some sentences that Jess or Dusty spoke. 

~9:15 p.m. - Bathroom trip under her own power, though Joyce reported she was "wobbly." Joyce did not have any urinary incontinence and was quite thrilled. She passed urine only. Wounds cleaned and fresh barrier cream applied. Joyce returned to her recliner ~9:35 p.m. 

Joyce not feeling like eating due to large lunch. Jess negotiated Joyce eat something small (two tablespoons rice pudding) with her evening medication. Evening medication taken ~9:56 p.m. 

Jess trained on OT exercises and PT back posture exercise for Joyce to attempt doing tomorrow before Dusty arrives to farmhouse.

Dusty working on obtaining new mail order blood glucose testing supplies for Joyce's kit, discovered that Arriva Medical went out of business in 2017. New source of supplies for Joyce's testing equipment found at Rite Aid in Moscow, Idaho.

Joyce settled in for the night ~10:15 p.m. Dusty and Jess packing up to head home, departing farmhouse ~10:35 p.m., Jess returning to farmhouse tomorrow morning ~8 a.m. to provide care for Joyce through the day. Dusty to arrive to farmhouse to assist with care for Joyce after working at Kenworthy Performing Arts Centre on maintenance projects.

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Participant observation: Joyce worked on attempting to cough up phlegm/mucous throughout the evening hours with varied success. Joyce unable/unwilling to get deep breaths to give herself deep coughs to help clear the mucous. Mucous clear/very pale, so unlikely she is sick. Jess and Dusty worked with Joyce on breathing, posture, and coughing exercises to help her clear the mucous. Joyce was not able to process verbal directions effectively. Dusty will contact Dr. Collins to see about obtaining orders for an Acapella Device to assist with clearing mucous.

Joyce continued to remove her oxygen line throughout the day and needed continual reminders from Dusty and Jess to return her line into place.

Jess worked with Joyce on correcting her posture, showing Joyce pictures taken to help explain how Joyce curls forward over her knees into a ball-like position in her recliner frequently (which appeared to help Joyce comprehend what she was doing that was causing concern).